This protocol applies to ureteropelvic junction (UPJ) obstruction in a specific clinical profile: the hydronephrotic kidney retains more than 40% differential renal function on MAG3 renography, the anteroposterior diameter of the renal pelvis is 20 mm or less on ultrasonography, and the patient has neither pain nor urinary tract infection.
The defining parameters of this group are preserved differential renal function above 40% on MAG3 scanning and an anteroposterior pelvic diameter at or below 20 mm on ultrasound, in the absence of pain and infection. Each of these thresholds carries clinical significance: differential function below 40%, anteroposterior diameter above 20 mm, the presence of pain, or active infection are recognised indicators that shift the management decision.
Management in this setting involves a reconstructive surgical procedure at the ureteropelvic junction — pyeloplasty — which may be carried out via an open, laparoscopic, or robot-assisted approach.
Technique selection criteria, the complete range of operative options, and the full clinical algorithm are available in the structured protocol below.The primary success measures are normal drainage from the kidney on renography at 12 months and resolving hydronephrosis on ultrasonographic scan at 6 weeks.
DOI: 10.1016/j.eursup.2012.01.004